Employability and career counseling for adolescents and adults with congenital heart disease.

Employability is an important issue for adolescents and young adults with congenital heart disease. This article provides an overview of specific federal laws that protect these individuals and information about state vocational rehabilitation programs. Guidelines are provided to help health care providers counsel their patients more effectively.

Atrial septal defects that present in infancy.

The diagnosis of isolated secundum atrial septal defect (ASD) in infancy is uncommon. We studied 26 infants with ASD confirmed at cardiac catheterization. Of these, nine were born prematurely, 15 presented with symptoms of congestive heart failure, and only three were noted to have the clinical features of an ASD in spite of large left to right shunts. All but two patients responded to medical management. Spontaneous closure of the ASD was documented in 39% (ten) of the patients at ages ranging from 2 to 8 years. Twelve patients underwent surgical closure at a mean age of 4 years. No variables at presentation were predictive of subsequent spontaneous closure. In view of the high rate of spontaneous closure and the success of medical therapy, most infants with symptomatic ASD may be managed medically, allowing sufficient time to observe whether spontaneous closure will occur.

Life insurance for children with cardiovascular disease.

To determine the life insurability of young people with cardiovascular disease, we sent questionnaires to 99 life insurance companies concerning 18 congenital defects, rheumatic heart disease, and four dysrhythmias. We received 50 responses (50%) from companies whose sales make up 41% of the life insurance market. The concensus of insurability for the defects listed was: standard rates--mild pulmonic stenosis, rheumatic fever without carditis, mitral valve prolapse without regugitation, and the following postoperative lesions: patent ductus arteriosus, atrial septal defect, pulmonic stenosis, ventricular septal defect; uninsurable--most unoperated lesions, postoperative lesions with complex dysrrhythmias, severe aortic insufficiency, idiopathic hypertrophic subaortic stenosis, Ebstein's anomaly, truncus arteriosus, tricuspid atresia; insurable at increased rates--most other defects, including dextrotransposition of the great vessels, postoperative aortic stenosis, mild aortic insufficiency, postoperative coarctation of aorta, postoperative tetralogy of Fallot, and small ventricular septal defect. We conclude that life insurance is available to many children with cardiovascular disease, including most postoperative patients. Whether the increased rates requested for some defects are prohibitive is a matter to be decided by each family.

Techniques to avoid injury of the conduction tissue during the surgical treatment of corrected transposition.

Sequential atrioventricular conduction may be maintained during surgery in most patients with corrected transposition of the great arteries by operative techniques that include: (1) closure of the ventricular septal defect to the left side of the ventricular septum through a right atrial-right atrioventricular valve exposure, and (2) spiral pulmonary outflow patch (with or without pulmonary valve replacement), which enlarges the outflow tract posteriorly combined with posterior subvalvular resection of fibromuscular outflow tract obstruction. These techniques place operative manipulation posterior to the pulmonary anulus and on the left side of the septum so as to preserve the conduction tissue, which is located anterior to the pulmonary anulus and on the anterior rim of the ventricular septal defect in corrected transposition of the great arteries.